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Team Up for Health (Making the Most of Your Visit): Northeast Valley Health Coorporation
1. Pacoima Health Center
Family Medicine Department
“Making the Most Out of Your Visit”
Today’s Visit: _____ / ______/ ______
1. “I am managing my Health…...”:
"Excellent” “Good” “Not Good” “Not Sure”
2. “What do I want to ASK my Provider today ?”
“Aprovechar su Visita a lo Maximo”
Fecha de Hoy: _____ / ______/ ______
1. “Manejo mi Salud ………”
“Excelente” “Bien” “No muy bien” “No estoy segura(o)”
2. “¿Que le voy a PREGUNTAR hoy a mi proveedor?”
****DO NOT FILE IN CHART—Give to DM Coord******
